Greetings colleagues, friends, partners,
Many European countries have ‘wasted the summer’, not heeding the ASPHER call to plan for the autumn ahead. The challenges of third wave pandemic will include different symptom presentations; more variable long Covid manifestations, and infections affecting more and younger people, alongside RSV and flu. School children are now the frontline for the third wave of infection in European countries. There is little evidence of any protection for children in England, or in the UK generally – Scottish rates soared when schools returned mid-August.
University populations are the most mobile group in our communities, able to turn small pockets of Coronavirus infection from their hometowns into raging outbreaks in their adopted residences. Vaccination rates are not as good as for older populations and students are (stereotypically perhaps?) described as having a mindset of invulnerability. Many governments are encouraging their higher education sectors to go back to in person teaching. The UK government has offered this unmanageable, contradictory and careless advice, ‘There is no requirement for social distancing or other measures within in person teaching. Providers are therefore able to shape their courses without restrictions to face-to-face provision”, while also stating that universities “should continue to make efforts to reduce the risk of transmission where possible.” The UK Independent SAGE believes universities should still stick to teaching remotely. What is your school doing? And why? Let us know.
Three faces of COVID?
For a meeting of the Alliance of International Science Organisations this month, I have been reflecting on my ‘Three faces of COVID’ analysis from the November ASPHER President’s blog. One ‘face’ was countries that did well from the first wave – implementing WHO public health measures from the start; one ‘face’ did poorly from the start – exhibiting complacency and indecision, and implementing measures when it was too late. The middle ‘face’ got it right in the first wave but couldn’t sustain public health measures into the second wave. Looking at selected country examples from these three faces, it is encouraging to see that the cumulative deaths are levelling off in many countries (Figure 1). The other good news for those countries who did well in the first wave, is that they ‘bought time’ – they are not catching up with the levels of deaths seen in the poorly performing countries. They have protected their most vulnerable, given vaccination its best chance and treatment options to be improved.
Unfortunately the death rate is still going up in the United States, UK and Serbia, and in many other parts of the world, especially in South America and Africa. Deaths are almost always now associated with the unvaccinated state. New cases are going up strongly in Israel and the UK, two early front-runners in the vaccine stakes. (Figure 2).
Figure 1. Figure 2.
Are the rates going up because of vaccine resistance from the Delta variant? Are they going up as vaccine efficacy wanes? And in both cases has ‘vaccine overconfidence’ meant these countries have thrown away social restrictions too soon? Countries like Portugal, Spain, Germany, France have retained masking and other social restrictions and case rates have not taken off again this summer. They have also now achieved high rates of vaccination, with two doses of mRNA vaccines, so may now be enjoying peak immunity. Croatia and Bulgaria are among those countries who keep a hold on mass gatherings. You can find details every week in ASPHER situation reporting. None of our countries can be complacent, and none of us can declare an end to the pandemic until all the world is clear. The vital task of enabling access to vaccines for the world needs to be given urgent attention. We urgently need a vaccine intellectual property rights waiver and support for wider international production of vaccines. ASPHER is working on this as an urgent priority.
Monti Commission draws light from the pandemic
Still, many countries, many politicians and public health authorities look forward optimistically to a better time, a post-COVID world, and are anxious also to give us the benefit of their wisdom about what has gone wrong and what lessons we should learn. The Monti report, ‘Drawing light from the pandemic’ was commissioned by WHO European Director General Hans Kluge. It gives us seven objectives towards a healthier and sustainable world: Operationalise the concept of One Health at all levels; take action at all levels of societies to heal the divisions exacerbated by the pandemic; support innovation for better One Health; Invest in strong, resilient and inclusive national health systems; create an enabling environment to promote investment in health; improve health governance at the global level; and improve health governance in the pan-European region. The Scientific Evidence supporting the Commission’s conclusions has been compiled by Editor-in-chief Martin McKee and published by the European Observatory. I strongly recommend it to you. It is an absolute tour-de-force and a major instant text book for public health – it should be required reading in all our schools of public health and for anyone at the start of their careers or a long way in theirs.
Martin has also drawn attention to the British government’s indifference to health, linking COVID and other health policy failures. Prime-Minister Johnson’s new Cabinet showed their commitment to COVID safety recently. Will this be an image reflected on in the 2120 pandemic?
Brexit still to strike UK
As with UK déjà vu over Covid winter planning, so the ugly face of Brexit rears its head again. It is clear we in the UK, but also in the EU, have not yet experienced the true impacts of this self-destructive policy. In the UK we are beginning to see the shortages of goods in shops, fast food stores, empty shelves in supermarkets, online purchases out of stock, a temporary NHS ban on routine blood tests in primary care. These are not the result of the UK-EU trade and cooperation deal – the British government has yet to implement its side of the deal on import controls. These are the result of the exodus of European Union drivers. The UK is set for another, more intense, winter of discontent.
Global air quality standards
Early in the pandemic people had a glimpse of what healthier urban air looked like. Sadly as the pandemic has moved on people have retreated to personalised transport where they can, for their own protection and home working is reducing. So we will still need major action on air quality at regional and local levels in a post pandemic world. Cue… WHO launched long-awaited revised Air Quality Guidelines on September 22nd. The guidelines update and toughen up standards for air quality for common air pollutants. More evidence has been gained over time on the deeply destructive nature of air pollutants in the 16 years since the last guidelines. ASPHER has been pleased to give its support to the new guideline. There will be a long and difficult road ahead to get the standards implemented. The statement of support has also been published here. We congratulate Nino Kuenzli and all our colleagues who were involved in the WHO report and in the professional society response.
As we go into the autumn we are about to hold our Deans’ & Directors’ Retreat. I look forward to meeting with you online to discuss the considerable body of work we are doing with members and partners. I look forward also to hearing from you about how ASPHER is meeting your needs and how we can continually improve our services to members and our advocacy for the public’s health. As ever, I am grateful to my Secretariat colleagues, Robert Otok, Lore Leighton and Rana Orhan for the immense work they do on our behalf.
Yours in health,
John Middleton
President ASPHER
September 23rd 2021